Medicaid Nursing Facility Quality Measure Payment Program Proposed
Posted on September 07, 2017
The Medical Services Administration (MSA) recently released a proposed policy to establish a new nursing facility quality measure initiative (QMI) payment program that would be funded by an increase in the nursing facility provider tax effective Oct. 1, 2017. The state fiscal year (FY) 2018 budget includes language stipulating the requirements for QMI payments, which will be calculated as a per-bed amount based on each nursing facility’s star rating from the Centers for Medicare & Medicaid Services (CMS) Nursing Home Compare website, adjusted by the facility’s proportion of Medicaid days to total patient days (Medicaid utilization rate). Under the proposal, the MSA would adjust the per-bed payment amount based on resident satisfaction survey results beginning in FY 2019.
To be eligible for a QMI payment under the proposed rule, a nursing facility must:
- Be a Class I, II or III nursing facility.
- Have a quality star rating on Nursing Home Compare. Nursing facilities with a star rating below 2.5 stars must submit an action plan to the MSA describing how it intends to use QMI funds to increase quality outcomes.
- Be Medicaid-certified.
- Not be designated as a Special Focus Facility by the CMS.
If the proposal is finalized, unadjusted QMI per-bed payment amount would be larger for facilities with higher star ratings and smaller for those with lower star ratings. Nursing facilities with a higher Medicaid utilization rate would receive a larger adjustment than those with a lower rate. In addition, nursing facilities that comply with the MSA’s satisfaction survey requirements would receive a larger adjustment to the per-bed amount compared to nursing facilities that do not.
The MHA encourages hospitals with long-term-care units to submit comments on the proposed policy to Ryan Tisdale at the MSA by Oct. 5. Members with questions should contact Jason Jorkasky at the MHA and are encouraged to email identified concerns to him by Sept. 30 as the MHA drafts its comment letter.
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